A patient presents with black discoloration on the dorsal tongue. Which of the following is the strongest risk factor?
A. Citrus fruit overuse
B. Excessive green tea consumption
C. Poor oral hygiene and tobacco use
D. High dairy intake
Which of the following antibiotics is preferred in C. difficile infection as first-line therapy.? 💊
A) Oral Vancomycin
B) Cefixime
C) Azithromycin
D) Gentamicin
💊Ends with “floxacin” (Ciprofloxacin, Levofloxacin, Moxifloxacin)💊
🔹 Avoid with calcium, iron, or milk > ↓ absorption
🔹 Covers both Gram-negative & atypical bacteria
🚫 Medicines to Avoid in Heart Failure (HF)🫀
🔺 NSAIDs – may cause fluid and salt retention, worsening HF.
🔺Corticosteroids – promote sodium and fluid retention; if needed, use the lowest dose for the shortest possible duration.
🔺 Beta-blockers – avoid starting in acute or uncontrolled HF; start only when stable.
🔺 Pioglitazone – causes fluid retention and can trigger HF exacerbation.
🔺 Alogliptin – linked to worsening HF in moderate to severe cases.
🔺 Vildagliptin – avoid in severe HF due to possible fluid retention.
🔺 Non-DHP CCBs (Diltiazem, Verapamil) – negative inotropic effect; avoid in HFrEF.
🔺 Flecainide & Dronedarone – can worsen arrhythmias and heart failure.
💊NAPLEX MedFact.
Ropinirole, a dopamine agonist used in Parkinson’s disease and restless legs syndrome, can cause several important side effects related to dopaminergic stimulation.
☑️Common adverse effects include nausea, dizziness, somnolence, orthostatic hypotension, and headache.
☑️Some patients may experience sudden sleep attacks or excessive daytime sleepiness, which can be hazardous during activities like driving.
☑️Neuropsychiatric effects such as hallucinations, confusion, and impulse control disorders (e.g. compulsive gambling, hypersexuality, or overeating) may also occur, particularly with long-term use.
☑️Gradual dose titration and monitoring for behavioral changes are essential to minimize these risks.
💊NAPLEX MedFact.
Tetracyclines have been associated with intracranial hypertension (also called pseudotumor cerebri), a rare but serious adverse effect.
☑️This leads to symptoms like headache, blurred vision, double vision, and papilledema (swelling of the optic nerve). If untreated, it can potentially cause permanent vision loss.
☑️The risk is higher in women of childbearing age and in patients who are overweight.
☑️For this reason, patients taking tetracyclines should be counseled to promptly report severe headaches or visual changes, and healthcare providers should discontinue the drug if intracranial hypertension is suspected.
A patient with GOUT is prescribed Allopurinol. He is also taking Azathioprine.
What adjustment is needed.?
A) Reduce azathioprine dose
B) Increase allopurinol dose
C) Stop azathioprine immediately
D) Add colchicine
Kawasaki Disease
Mnemonic: KAWASAKI
K → Kid <5 years
A → Adenopathy (cervical lymph)
W → Warm (Fever) + Vasculitis
A → Atypical mucosa
S → Strawberry tongue + Skin rash
A → Anti-endothelial antibodies
K → Koronary artery aneurysm
I → Increased platelets